摘要
目的系统评价尼可地尔在对比剂肾病(CIN)预防中的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、EBSCO、Scopus、中国知网和万方数据库,检索时间为建库至2020年6月,同时查阅相关会议摘要和网站,检索尼可地尔预防CIN的相关内容。采用Stata 15.0软件进行荟萃分析。结果共纳入8项随机对照试验,包括1755例患者。其中尼可地尔(+)组876例,尼可地尔(-)组879例。荟萃分析结果显示,尼可地尔(+)组的CIN发生率明显低于尼可地尔(-)组(OR=0.31,95%CI:0.21~0.45,P=0.000)。亚组分析结果显示,尼可地尔口服给药(OR=0.28,95%CI:0.18~0.44,P=0.000)的疗效优于静脉给药(OR=0.40,95%CI:0.20~0.78,P=0.007)。尼可地尔(+)组术后48 h血清肌酐水平低于尼可地尔(-)组(SMD=-0.29,95%CI:-0.54~-0.04,P=0.022),而两组术后24 h(SMD=-0.14,95%CI:-0.35~0.08,P=0.220)和72 h(SMD=-0.23,95%CI:-0.47~0.01,P=0.057)的血清肌酐水平有降低趋势,但差异无统计学意义。尼可地尔(+)组术后48 h胱抑素C水平低于尼可地尔(-)组(SMD=-0.40,95%CI:-0.79~-0.02,P=0.041),而两组术后24 h(SMD=-0.10,95%CI:-0.29~0.10,P=0.334)和72 h(SMD=-0.17,95%CI:-0.37~0.02,P=0.075)的胱抑素C水平有降低趋势,但差异无统计学意义。两组主要不良事件的发生率比较,差异无统计学意义(OR=0.66,95%CI:0.44~1.01,P=0.054)。结论尼可地尔在CIN的预防中发挥着积极作用,且术后应用尼可地尔是预防CIN的关键。
Objective To systematically evaluate the clinical efficacy of Nicorandil in the prevention of contrast-induced nephropathy(CIN).Methods The databases,including PubMed,Embase,Cochrane Library,EBSCO,Scopus,CNKI and WanFang Data from inception to June 2020 were computer searched for eligible trials evaluating the clinical efficacy of Nicorandil in the prevention of CIN.Meanwhile,we reviewed the relevant conference summary and websites.Meta-analysis was performed using Stata 15.0 statistics software.Results A total of 8 randomized controlled trails(RCT),involving 1755 patients,with 876 patients in Nicorandil(+)group and 879 patients in Nicorandil(-)group were collected.Meta-analysis showed that the incidence of CIN was significantly lower in Nicorandil(+)group than in Nicorandil(-)group(OR=0.31,95%CI:0.21 to 0.45,P=0.000),and the subgroup analysis showed that oral administration(OR=0.28,95%CI:0.18 to 0.44,P=0.000)has a greater efficacy compared to intravenous route(OR=0.40,95%CI:0.20 to 0.78,P=0.007).The level of serum creatinine(SCr)was lower in Nicorandil(+)group than that in Nicorandil(-)group(SMD=-0.29,95%CI:-0.54 to-0.04,P=0.022)after coronary angiography(CAG)or percutaneous coronary intervention(PCI)for 48 h,and had a descending trend after the operation for 24 h(SMD=-0.14,95%CI:-0.35 to 0.08,P=0.220)and 72 h(SMD=-0.23,95%CI:-0.47 to 0.01,P=0.057).The level of cystatin C(Cys C)was lower in Nicorandil(+)group than that in Nicorandil(-)group(SMD=-0.40,95%CI:-0.79 to-0.02,P=0.041)after CAG or PCI for 48 h,and had a descending trend after the operation for 24 h(SMD=-0.10,95%CI:-0.29 to 0.10,P=0.334)and 72 h(SMD=-0.17,95%CI:-0.37 to 0.02,P=0.075).The incidence of major adverse events was not statistically significant in the Nicorandil(+)group compared with the Nicorandil(-)group(OR=0.66,95%CI:0.44 to 1.01,P=0.054).Conclusions Nicorandil plays an active role in the prevention of CIN,and postoperative oral administration of nicorandil has better efficacy than intravenous administration.
作者
陆丽洁
朱永翔
李烽
龙明智
Lu Lijie;Zhu Yongxiang;Li Feng;Long Mingzhi(Department of Cardiology, the Second AffiliatedHospital of Nanjing Medical University, Nanjing 210011, China)
出处
《中国心血管杂志》
2021年第3期277-281,共5页
Chinese Journal of Cardiovascular Medicine
基金
南京市卫生科技发展专项资金(ZKX18051)。
